PMR Flare

Hello, friends. I have had PMR since late October 2023, and have been on methylprednisolone (because prednisone didn't work) since late November. Currently (Sept 2025) I have been down to 2 mg a day, which is a little difficult since the smallest tablets come in tiny 4 mg format, and it is difficult to get an accurate cut. Anyway, I thought I was doing well on this for about 3 weeks, so thought to go down to 1 mg (so far as I can do 1/4 tablet--it's hard to be accurate) for 2 days, then 2 mg for a day, and so on. Unfortunately, I felt ill after doing this twice--more pain, hot face, etc, and so on the weekend took 3 mg to ease things. That helped, but then today I went back to 2 mg. Is it possible that I am not actually flaring, but having withdrawal symptoms. My lips are "buzzy", my face is hot, and I am stiff when I sit for too long.

I don't want to overdo the acetaminophen, but these really do help. Once or twice I have taken a naproxen, but I know that is not a good idea. Any thoughts out there? should I just "tough it out" and see what happens after a few weeks, or should I go back to alternating 3-2-3 like I was. I had the goal of being off all this by Thanksgiving.

Ibuprofen and naproxen are OTC and might help with the inflammation.
I usually take NSAIDs with a meal.

@edithmary I am also on Methylpred. I started with regular pred but the Methypred was far more effective, I am now down to 2.5 mg/day by alternating 2mg, 3mg every other day to make the effect of 2.5 mg/day. For the past month when I started at 3mg/day, I began to have signs of PMR upon waking. I normally need to use the bathroom each morning around 3 am. At that time I started to take 2 extra strength Tylenol. I did fine. As my body got use to to the 3mg/day, I started taking only 1 extra strength Tylenol. Five days ago I started my new methylpred dose of 2.5/day. Upon waking for the day (around 7am), I felt a bit more PMR symptoms in my neck and upper arms. Once again, as I need to use the bathoom around 3am each morning, I have upped my Tylenol back to 2 pills. Now when I wake up for the day around 7am my PMR symptoms are less. I will continue with the 2 extra strength Tylenol to let my body get use to this new Methylpred dose of 2.5. In about a week I will again decrease the Tylenol to 1 pill. This method seems to work for me. As per my Rheumy, the Tylenol is better than upping the Methylpred. As a side, I am experiencing changes in my body as I decrease the dose of the methylpred. My hot flashes are soaring. Regarding the difficulty of spliting the pills into quarters, I use a tweezer to place the pill in the pill slicer. When you have to halve the halfed pill, place the finished side of the pill to the slicer and then it will not crumble.

Or in the freezer. Helps with splitting.

@edithmary I am also on Methylpred. I started with regular pred but the Methypred was far more effective, I am now down to 2.5 mg/day by alternating 2mg, 3mg every other day to make the effect of 2.5 mg/day. For the past month when I started at 3mg/day, I began to have signs of PMR upon waking. I normally need to use the bathroom each morning around 3 am. At that time I started to take 2 extra strength Tylenol. I did fine. As my body got use to to the 3mg/day, I started taking only 1 extra strength Tylenol. Five days ago I started my new methylpred dose of 2.5/day. Upon waking for the day (around 7am), I felt a bit more PMR symptoms in my neck and upper arms. Once again, as I need to use the bathoom around 3am each morning, I have upped my Tylenol back to 2 pills. Now when I wake up for the day around 7am my PMR symptoms are less. I will continue with the 2 extra strength Tylenol to let my body get use to this new Methylpred dose of 2.5. In about a week I will again decrease the Tylenol to 1 pill. This method seems to work for me. As per my Rheumy, the Tylenol is better than upping the Methylpred. As a side, I am experiencing changes in my body as I decrease the dose of the methylpred. My hot flashes are soaring. Regarding the difficulty of spliting the pills into quarters, I use a tweezer to place the pill in the pill slicer. When you have to halve the halfed pill, place the finished side of the pill to the slicer and then it will not crumble.

@aisp3b How on earth do you do 2.5 mg of Medrol? Mine come in 4 mg tablets, so half a tablet is 2, and a quarter is 1 mg. I don't see how it is possible to divide a tablet into eighths? Do you get Medrol (Methylpred) in a different amount per pill? I also am using Tylenol to help, and have been helped over night with the long-lasting Tylenol for Arthritis. But I am reluctant to take too much of that, either. Thanks for the suggestion of putting the finished side of the pill!